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Tuesday, November 5, 2013

Can Guardians Pull the Plug on Life Support? In Minnesota, the Supreme Court Will Decide.

The Estate of Denial blog reports that the Minnesota Supreme Court has taken on an end-of-life case with the key question, "Should guardians be required to receive a judge’s sign-off before pulling the plug, or is it already part of the powers granted when they sign on for the job?"

The case, In re the Guardianship of Tschumy, involves a mentally disabled man who suffered severe brain damage after choking on some food. Tschumy could not survive without life support, and he had no family or health directive to indicate whether to proceed with care. According to Estate of Denial,

Allina Health System requested that a judge allow [Tschumy] to be removed from life support, either by clarifying that his guardian, Joseph Vogel, had the right to make the decision or by issuing an order from the bench.

District Judge Jay Quam authorized the termination of Tschumy’s life support, but denied the guardian’s request for the sole power to make that decision. Tschumy died.

In a follow-up order, Quam reasoned that although guardians have a strong case to make end-of-life decisions under a state law that grants them the power to allow or withhold medical care, it does not specifically allow them to terminate life ­support. Until the Legislature decides to revisit the issue, only a judge or legally authorized representatives can order life support removed.

“No one­­ — not even a judge — can look into the future and into the hearts and minds of a guardian to know with confidence that he or she will decide appropriately when, and if, an end-of-life decision needs to be made,” he wrote.

Attorneys for Vogel appealed. Last summer, the Minnesota Court of Appeals reversed Quam’s ruling, reasoning that the final authority lies with guardians and that end-of-life decisions shouldn’t be dictated by the court, relying on a 1984 Supreme Court ruling that said judges were permitted to allow removal of life support without a secondary hearing.

While Quam called the same law too vague, the Appeals Court countered that imposing a requirement for additional court sign-off “would be inconsistent with the Supreme Court’s recognition of a private, medically based model of decisionmaking.”

The Minnesota Supreme Court is expected to clarify just how far a guardian's authority extends and whether end-of-life decisions are an inherent part of that authority.